This application entitled Adapting Pediatric Obesity Treatment Delivery to Address Health Disparities addresses broad Challenge Area (05): Comparative Effectiveness Research and specific Challenge Topic 05- MD-102: Prevention of Chronic Diseases in Disparity Populations. We will test the preliminary effectiveness of an evidence-based intervention for pediatric obesity, adapted for low income families and delivered to parents in pediatric primary care practice, and evaluate factors to improve future iterations of the intervention. Obesity in children and adults has increased dramatically during the last two decades. Currently, more than 32% of American children are obese or overweight and are at risk of developing early major health problems. Health disparities are evident in obesity. Low income children are at higher risk of obesity regardless of ethnicity and the risks for obesity and related health problems are greater in disparity subgroups of the population. Intervention with high risk obese children is an important step in addressing the health and financial consequences of this dire public health problem. Our pilot work showed that a program tailored for low income families targeting parents as primary change agents for their children is feasible to deliver and may impact child weight gain. The proposed project tests our findings within a rigorous research design. We propose to employ a mixed quantitative and qualitative research design to test the preliminary effectiveness of an adapted pediatric weight management intervention for low income and racially diverse families. In a randomized controlled design, we will enroll 140 obese children ages 2-11 years and their primary caregivers from an urban pediatric clinic that serves 18,000 children/year of whom 70% are Medicaid- insured and 70% are African American. Families will be randomized to the HEALTH for Families intervention (HFF) or enhanced usual care control. The intervention supports parents in making family changes in eating and activity habits to affect the weight outcomes of their obese children. Materials are adapted for low literacy level;sessions are collaborative, behavioral, and adapted to reduce family time burden. Primary outcome measures at baseline, end-of-treatment (6M) and follow up (9M) are: child percent overBMI and mean number of daily steps and of high calorie/low nutrition foods consumed per week. A subset of families will complete qualitative interviews gathering information about challenges and barriers families experience in addressing eating and activity habits as well as changes to improve the intervention. Project results will inform future iterations of the intervention to address pediatric obesity in this high risk subgroup for health disparities. The proposed randomized clinical trial will examine the effects of an evidence-based intervention for pediatric obesity adapted for a low income, racially and ethnically diverse disparity population on child percent overBMI in a sample of 140 obese children ages 2-11 years. The long term public health consequences of pediatric obesity are dire with the current overweight generation of children perhaps the first since the Great Depression to experience a reduction in life expectancy over previous generations, providing the current trend continues, and there is no clear indication that rates of obesity in children are stabilizing. Intervening as early as possible, especially with those children and families comprising the highest risk subgroups for the worst obesity-related outcomes, is one of the highest priorities nationally.